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Article - RECOVERY: HELPS, HINDRANCES AND THE WAY AHEAD

Summary/Abstract

An empirical look at recovery, focusing on building ‘recovery capital’, tearing down barriers – and implications for treatment and policy.

Content

Treatment services tend to be relatively short – notably four weeks in rehab – and skills acquired during treatment do not always endure after treatment as the individual might revert to pre-treatment behaviours and socialisation patterns. Participation in 'stepped down' continuing care after treatment is recommended and effective to solidify treatment gains (McKay et al, 1998) – but most programmes do not offer these services. There is where 12-step fellowships such as Alcoholics and Narcotics Anonymous step in as aftercare (Tonigan, Toscova, and Miller, 1996). These organisations are particularly well-suited to provide ongoing recovery support from chronic substance abuse and dependence because, unlike limited-time formal services, they are widely and consistently available free of charge. Participation in 12-step groups exposes members to peers – who share common problems they seek to address – succeeding at remaining drug free, so providing role models with whom they can identify, evidence that recovery is attainable, strategies to cope with temptations to use and with other stressors, emotional support to deal with the challenges of recovery, a spiritual foundation for those who choose (Alcoholics Anonymous World Services, 1939-2001), and opportunities to socialise with non drug-using peers (Humphreys & Noke, 1997; Humphreys, Mankowski, Moos & Finney, 1999; Laudet, Cleland, Magura, Vogel & Knight, 2004; Morgenstern & McCrady, 1993; Morgenstern et al, 2003; for review, see Humphreys, 2004). Among people concurrently in professional treatment, 12-step meeting attendance produces independent and additive effects to treatment outcomes (Fiorentine & Hillhouse, 2000). This support is especially important after treatment ends: it is a strong predictor of abstinence even in long-term studies (Kaskutas et al, 2005; Kelly, Stout, Zywiak & Schneider, 2006; Laudet et al, 2007; Morgenstern et al, 2003). The effectiveness of 12-step participation rises in tandem with addiction severity (Tonigan et al, 1996). And one study reported a stronger link between 12-step attendance and abstinence among patients who were younger, white, less-educated, unstably employed, less religious and less interpersonally skilled, individuals who might have fewer social resources and so benefited more from the fellowship and support for abstinence (Timko, Billow, & DeBenedetti, 2006). -- See attached PDF to read entire article